The requirements
- In ST1, a minimum of four COTs and/or Mini CEXs are required (this is four in total – for example, two COTs and two MiniCEXs for a total of four COTS and MiniCEXs).
- In ST2, a minimum of four COTs and/or Mini CEXs are required (this is four in total – for example, two COTs and two MiniCEXs for a total of four COTS and MiniCEXs).
COTS are completed in primary care placements, and in ST1 and in ST2, two COTs should be completed per primary care placement. MiniCEXs are completed in non-primary care placements and in ST2 two MiniCEXs should be completed per non-primary care placement.
- In ST3, a minimum of seven COTs are required.
COTs of all types should be completed over the course of training including audio, face to face/in person (i.e. patient is in the same room as the registrar) and virtual/remote. At least one Audio COT and one face to face/in person COT should be completed over the course of training. For clarity, if there are no primary care placements in a training year (e.g. ST2 consists only of non-primary care placements), only MiniCEXs should be completed. A minimum of four would still apply – for example, if the ST2 year consists only of non-primary care placements, four MiniCEXs should be completed. If there are no non-primary care placements in a training year (e.g. ST2 consists only of primary care placements), only COTs should be completed. A minimum of four would still apply – for example, if the ST2 year consists only of primary care placements, four COTs should be completed.
How the COT works
During training, consultations should be recorded and reviewed as this is an essential way of improving consultations.
There are four types of COT, all using the same form and COT criteria:
- In person (live)
- In person (recorded)
- Virtual consultation (live)
- Virtual consultation (recorded)
The Audio-COT is for telephone consultations and uses a different form. Please see the Audio-COT section for further details.
Selecting consultations
The choice of consultations should cover the full breadth of Clinical Experience Groups and be in different settings, such as surgery consultations, home visits and Unscheduled urgent care / Out of Hours. There is no minimum or maximum length of consultation. Complex and/or challenging consultations are more likely to generate learning.
It can be helpful to vary the approach to consultation selection (i.e. some consultations are selected by the registrar and others by the supervisor) for assessment throughout the training year to ensure there is an accurate representation.
Over the course of the GP training programme, it is expected that COTs will be completed that relate to most of the Clinical Experience Groups. However, Educational Supervisors will be able to give relevant advice in the context of the rest of the Portfolio.
Patient consent
Any consultations that are recorded will require the patient’s consent. A sample consent form is available below.
Reviewing and assessing the COT
COTs can be assessed by either an approved GP Educational Supervisor (ES) or an approved, appropriately trained, and updated GP Clinical Supervisor.
Consultations should be reviewed with the Educational or Clinical supervisor, who will relate their observations to the WPBA Capability framework and COT or Audio-COT criteria. The performance criteria for face-to-face consulting can be found below and for telephone consulting within the Audio-COT section. The Educational or Clinical supervisor will grade each section of the consultation, make an overall judgement on performance and provide formal feedback with recommendations for further development.
It is possible that not all assessed areas within a COT will be graded as competent in all consultations. However, by the end of ST3, it is expected that a GP registrar will have been graded as competent in all areas in a COT at some point during ST3, and that the most recent COTs are graded at - or above - the level expected for that stage of training.
Patient consent
The patient must give consent to the consultation either being observed by a second doctor or being recorded, in accordance with the guidelines for consenting patients. Please see the separate patient consent document for further information on gaining informed consent for recording the consultation below.
Collecting evidence from the consultation
The supervisor will review the consultation with the registrar, relating their observations to the WPBA Capability framework and COT performance criteria - see below. The supervisor will then make an overall judgement and provide structured feedback, with recommendations for further development. You can reflect on a consultation that was assessed with a COT in a Clinical Case Review (CCR) to demonstrate additional capabilities.
Capabilities
The COT has been mapped to the RCGP Capability statements, which in turn will link to Workplace Based Assessment evidence in the Educational Supervisor Review.
Assessing the COT
Either an approved GP Educational Supervisor, or approved, appropriately trained and updated GP Clinical Supervisors can assess COTs.
Educational Supervisors and some Clinical Supervisors have access to the Portfolio. If this is the case, the supervisor can log on and complete the assessment. For those who do not have access to the Portfolio, a ‘ticket’ should be sent in advance to the assessor, which will allow a direct link to the online assessment form.
To use the ticketed feedback system, click on ‘generate a new ticket’ within the Portfolio, select the ‘COT assessment form’ and complete the assessor’s details. An email will then be sent providing a login code for the assessor to use.
Each area within the COT can be assessed as ‘not observed’, ‘needing further development’, ‘competent’ or ‘excellent’. The supervisor rates against detailed performance criteria. ‘Competent’ refers to the standard that would be expected of a GP registrar on completion of their training. A global judgement is made at the end of the assessment tool regarding the safety of the consultation.